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By Angela C.C. Wang, MD, CTS President
How is your empathy tank today? from the teachings of Marcus Aurelius
"When you wake up in the morning, tell yourself: [Some of] The people I deal with today will be meddling, ungrateful, arrogant, dishonest, jealous and surly. They are like this because they can't tell good from evil. But I have seen the beauty of good, and the ugliness of evil, and have recognized that the wrongdoer has a nature related to my own — not of the same blood or birth, but of the same mind, and possessing a share of the divine. And so none of them can hurt me. No one can implicate me in ugliness. Nor can I feel angry at my relative, or hate him. We were born to work together like feet, hands, and eyes, like the two rows of teeth, upper and lower. To obstruct each other is unnatural. To feel anger at someone, to turn your back on him: these are obstructions." Adapted from Marcus Aurelius, Meditations
As I write this column a few days before Thanksgiving, I can't help but look ahead and start to dread the Monday morning after the long weekend when the deluge of pent up coughs, chest pains and dyspnea will flood our phone lines and lobby. Driven by fear, pain and perhaps a tinge of guilt at having overindulged during the holiday, the patients are demanding to be seen and attended to — now. My task list filling the screen, each line with its red "overdue" dot, a shout for attention. The red folder sitting on my desk filled with notes from my nurse, refills requiring signatures, prior authorizations, questions and more questions create a constant, distracting, guilt-inducing drain on my attention. And so my empathy tank dribbles dry, despite all my attempts to maximize efficiency and make the tank last longer. Will I have something left for my family when I return home at night?
I sometimes feel like I am under attack on busy clinic days. But I know that it is imperative to avoid the defensive mechanisms that counterintuitively worsen the situation, by turning even simple requests into an assault on my time and patience. I remember that it is not "Me versus Them" but it is "Me and Them." That I am hugely fortunate to have a job where I can wake up every morning knowing that I am going to make a positive difference in someone's (hopefully many someone's) life.
It also helps to belong to an organization like CTS. Our personal and professional backgrounds are diverse, but we are bound in our enthusiasm and passion for patient care. Volunteering for CTS may seem like the absolutely wrong thing to do when one is stressed and short of time. But, choosing freely to give my time and labor to a profession I love, is empowering. I miss being around trainees and the rejuvenating give and take of being immersed in the educational process. CTS provides me the opportunity of staying engaged with younger members of our profession whose hope and energy help keep my empathy tank not just full, but topped off.
I would also like to take this opportunity to thank Shannon Jamieson, our executive director and her staff. She is the true heart of our organization. Without her dedication and guidance, we would not be able to able to continue to grow as a professional society as we strive to be the place where respiratory healthcare professionals from all over the state come to engage, collaborate and inspire.
In addition to our main program on Saturday, January 30, featuring updates on ICU medicine and chronic lung infections, this year's Carmel conference features a Fluoroscopy course on Friday, January 29, for colleagues seeking to certify or recertify for their supervisor's certificate. We are also launching our COPD Initiative with a multidisciplinary COPD symposium that features cutting edge speakers and topics in a collegial and interactive environment. Dr. Atul Malhotra, current ATS President and chief of Pulmonary, Critical Care and Sleep Medicine at UCSD will be a keynote speaker at both the COPD Symposium and Saturday program. He will be joined by Dr. Chuck (Charles) Daley, former CTS President and now Chief, Division of Mycobacterial and Respiratory Infections National Jewish Health.
Early bird conference registration is open now. See you there!
By Bryan Benn, MD, PhD and Laura L. Koth, MD, UCSF
Sarcoidosis is a systemic inflammatory disease of unknown etiology with no cure. It is a heterogeneous disease, affecting many different organs, although most commonly it involves the lungs. Treatment usually focuses on systemic immunosuppression, but this choice should be carefully considered before initiation as many patients with isolated pulmonary involvement will have mild disease and up to 50 percent of patients may undergo spontaneous remission within two years (1). Strong indications for treatment are clear organ damage or evidence of progressive inflammatory disease (2). Additional indications include most types of central nervous system disease, cardiac disease, hypercalcemia and ocular inflammation (2). Thus, when evaluating patients, it is important to determine the extent of organ(s) involvement and the severity of active inflammation before beginning systemic therapy.
- Careful evaluation of sarcoid patients is needed for extent of organ involvement and
disease activity prior to initiation of treatment because not all patients require systemic
- Determining if nonspecific patient complaints are related to sarcoidosis is a challenging
problem. A trial of conservative treatment is usually appropriate.
- Suspected cases of cardiac sarcoidosis warrant evaluation at local centers with expertise
in diagnosis, treatment and management.
- Both basic science and clinic research efforts are actively pursuing better understanding
of the complex mechanisms underlying this disease process and the development of novel
therapeutic agents for treatment.
By Richard Casaburi, Ph.D., MD
I've been involved in COPD research for over 25 years. I can remember when medical science had virtually nothing to offer people suffering from the consequences of COPD. Things have changed a lot. We have drugs that make breathing easier and make it possible for people to be more active. A number of strategies have been validated that decrease the frequency of COPD flare-ups; well-treated people with COPD now get sick less often. Pulmonary rehabilitation has been fine-tuned and individualized; it is the most effective therapy we have to improve the quality of life. It's time to turn to new challenges. In the coming years we need to look for therapies that slow or even reverse COPD progression and also prolong life. Though a cure doesn't seem like a reasonable possibility in the near future, it is now a goal to work toward.
US National COPD Coalition
National COPD Awareness Month
By Heidi Flori, MD, FAAP, CTS Past President and Previous Chair, CTS Pediatrics Committee
As a pediatric intensivist, I know first hand how deadly influenza infection can be in children. Whether influenza infection is the primary culprit, stimulates status asthmatics or, more ominously, paves the way for rapidly fatal bacterial superinfection and septic shock (Hall et al, Crit Care Med 2013; 41) the viral infection itself is a key first step. Vaccination can be the key to disarming all of it! (Ferdinands et al, Journal of Infectious Disease 2014, 210) Please see the link from our colleagues in the American Academy of Pediatrics to learn more detail about this year's flu vaccine.
(excerpt from Red Book Online Special Alert — Nov. 13)
Flu activity is low in the United States at this time. It is not possible to say when influenza activity will increase, which virus(es) will predominate, or who will be most severely impacted by influenza infection. Vaccination is still the most important step in protecting children against influenza. The Centers for Disease Control and Prevention (CDC) advises clinicians to expect sporadic vaccine delays, but no shortages. A recent AAP News Breaking News article shares additional information regarding potential influenza vaccine delays.
Everyone 6 months of age and older needs an influenza vaccine each year. It takes about two weeks after vaccination to develop antibodies for protection against influenza. Vaccination of people at higher risk of developing serious influenza-related complications is especially important to decrease their chance of severe illness. This includes children with chronic medical conditions, such as asthma, diabetes mellitus, hemodynamically significant cardiac disease, immunosuppression or neurologic and neurodevelopmental disorders. Everyone should be vaccinated as soon as the vaccine is available in their area, especially anyone who plans to visit or travel during this holiday season. (Read Full Article)
Advances in Pulmonary and Critical Care Medicine:
ARDS, ECMO and Chronic Lung Infections
Mycobacteria, Bronchiectasis & the Airway Microbiome
PLUS – TWO NEW pre conference Friday programs:
Fluoroscopy Safety for the Medical Provider (State Recognized CME Course)
COPD Today: A Team Approach (Symposium)
Full Conference Details
Early Bird Registration (through Dec. 15)
The number of American adults who light up has fallen to a new low of just 14.9 percent, according to the latest figures from the U.S. Centers for Disease Control and Prevention. The CDC recently published 2014 figures showing that last year, 16.8 percent of adults smoked. But the new statistics — which tracked smoking rates to June of this year — show the number has tumbled even further.
Exposure to air pollution early in life may contribute to the development of asthma in childhood and adolescence, a European study suggests. Researchers followed more than 14,000 children from birth through ages 14 to 16 and found those born in communities with more polluted air were more likely to develop asthma than other kids, particularly after age 4.
Medical News Today
Adults in the U.S. who use only smokeless tobacco products have higher levels of biomarkers of exposure to nicotine and NKK — a cancer-causing toxicant — compared with those using only cigarettes, according to research published in Cancer Epidemiology, Biomarkers & Prevention.
After the curtain rose, a young woman sang the first line of Sting's "Every Breath You Take" in a slow but powerful voice. Two more soloists followed, and then an entire chorus of 18 people filled the historic auditorium with a rich, commanding sound. This was no ordinary choir. Each of the singers has a chronic respiratory disease that years ago would likely have limited their activities.
Medical News Today
Children who develop severe wheezing and difficulty breathing after a common cold, with a risk of severe lower respiratory tract illness, could benefit from taking a common antibiotic at the first sign of cold symptoms, according to a report in JAMA. Respiratory infections commonly affect young children. Most recover fairly easily from the typical coughs and congestion, but a significant number develop illnesses severe enough to cause breathing problems.
New research from the University of Cincinnati has identified biomarkers and potential therapeutic approaches that may hold the key to treating pulmonary alveolar microlithiasis, a rare lung disease. The study was published in the journal Science Translational Medicine.
In a study of 526 adolescents and young adults who were asked about how much they exercised, researchers found that compared with moderate physical activity, high physical activity levels were linked with poorer asthma control in females, but not males. The findings were published online in the journal Respirology.
Lung Disease News
A newly published study suggests that a fungal species found in the lungs of patients with cystic fibrosis develops a genetic mutation that allows it to adapt to and resist rival bacteria. The paper was published in the journal PLOS Pathogens. Patients with CF suffer from mucus buildup in the lungs that makes them particularly vulnerable to infections with bacteria and fungus.
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